For years, the evidence supporting exercise during cancer treatment has continued to grow. Yet one of the greatest challenges in Exercise Oncology remains unchanged: How do we move exercise from a guideline recommendation into the routine clinical care of people with cancer?
A major new randomized trial published in The Lancet Oncology provides an unusually important answer.
The STAMINA trial is An integrated lifestyle intervention for mitigation of adverse effects associated with androgen deprivation therapy for prostate cancer is important not simply because exercise produced benefits. Its greater contribution may be demonstrating how a large-scale Exercise Oncology program can actually be organized, integrated into cancer care, delivered in the community, sustained for a year, and shown to be cost-effective.
Why Androgen Deprivation Therapy Makes Exercise So Important
Androgen deprivation therapy (ADT) is a cornerstone of prostate cancer treatment, but its adverse effects can substantially affect quality of life. The authors note that fatigue occurs in up to 77% of men receiving ADT. Although supervised exercise is recommended in national and international prostate cancer guidelines, it remains infrequently incorporated into routine clinical practice.
This gap between what guidelines recommend and what healthcare systems deliver is one of the central problems facing Exercise Oncology.
The investigators specifically identified several barriers: lack of specialized professional training, uncertainty about exercise safety, inadequate behavioral support, and perhaps most importantly is the absence of an established infrastructure for referral and delivery. They concluded that an integrated clinical pathway with reliable, large-scale delivery infrastructure is essential.
That observation has implications extending far beyond prostate cancer.
What Was the STAMINA Trial?
STAMINA was a multicenter randomized trial conducted across 15 National Health Service trusts in England involving 700 men receiving ADT for prostate cancer. Participants were a median age of approximately 72 years, and nearly three-quarters had two or more comorbidities, making this a population highly relevant to real-world oncology practice.
Participants were assigned either to an enhanced usual-care program or the STAMINA lifestyle intervention.
STAMINA included:
- supervised aerobic and resistance exercise
- individualized exercise prescription
- dietary advice
- behavioral support
- safety-to-exercise screening
- complimentary gym membership
- coordination between the cancer-care team and trained community exercise professionals.
Exercise initially occurred twice weekly for 13 weeks, followed by progressively less frequent supervision over the remainder of the 12-month program. Exercise was initially delivered one-to-one and could transition into small groups of no more than five participants.
This is an important distinction: STAMINA was not simply an exercise study. It tested an Exercise Oncology delivery system.
The Results: Better Quality of Life and Less Fatigue
At 12 months, STAMINA was superior to Optimised Usual Care for both primary outcomes.
Cancer-specific quality of life measured by FACT-P was significantly better, with an adjusted mean difference of 4.5 points, while fatigue measured by FACIT-F was also significantly improved, with an adjusted difference of 1.9 points. Benefits were also observed across measures of general quality of life and several physical, emotional, social/family, and functional wellbeing domains.
Importantly, the FACT-G quality-of-life benefit exceeded the study’s minimum clinically important difference threshold.
Exercise behavior also remained significantly better at 12 months, suggesting that STAMINA did more than temporarily place people into an exercise program. It helped establish sustained physical activity behavior.
Exercise Was Deliverable at Scale
This may be the most important finding for organizations developing Exercise Oncology programs.
The researchers trained 183 hospital-based personnel and 157 gym-based personnel. Among the 389 men assigned to STAMINA, 95% attended at least one supervised exercise session, and the median participant attended 28 sessions. Aerobic exercise occurred during 99% and resistance exercise during 97% of attended sessions.
The model deliberately connected two environments that often remain separated:
Cancer center → referral and safety assessment → trained community exercise professional → supervised exercise → continuing behavioral support.
The authors describe the integration of cancer teams with trained community exercise professionals across hospitals and community fitness centers as a major reason the program is generalizable. They characterize STAMINA as a scalable, deliverable model that could serve as a template for best practice.
And It Was Cost-Effective
Exercise Oncology programs increasingly need to demonstrate not only clinical benefit but also economic value.
STAMINA provides important evidence here as well.
The investigators calculated an incremental cost-effectiveness ratio of approximately £13,920–£19,077 per quality-adjusted life-year (QALY). Even using conservative assumptions, the intervention remained more than 70% likely to be cost-effective. Longer-term modeling suggested that its economic value could become even greater over time.
The authors also reported that the program could be delivered for less than £1,000 per patient annually even under the more expensive scenario evaluated.
For health systems asking how they can justify investment in Exercise Oncology, these are highly relevant findings.
What STAMINA Tells Us About Organizing Exercise Oncology Programs
This publication deserves attention from cancer centers because it shifts the discussion from “Does exercise help?” toward “How should we deliver exercise as part of cancer care?”
STAMINA suggests that an effective Exercise Oncology program requires several interconnected components: clinician identification of appropriate patients, a defined referral pathway, safety screening, trained exercise professionals, individualized aerobic and resistance prescriptions, behavioral support, longitudinal follow-up, community-based delivery capacity, and measurement of patient outcomes.
Most importantly, the exercise prescription was embedded into the standard prostate cancer clinical pathway rather than offered as an optional wellness service operating outside oncology care.
That distinction is fundamental.
Exercise Oncology should increasingly be viewed as a clinical service line, not simply as a fitness program for cancer survivors.
A Model Beyond Prostate Cancer
Although STAMINA specifically studied men receiving ADT, its organizational implications are much broader.
The investigators themselves suggest that the model could potentially translate to other cancer populations, including breast and colorectal cancer.
There are limitations. The population was overwhelmingly White, participants often rated themselves relatively fit, dietary adherence was not directly measured, and the trial did not demonstrate differences in the measured physical outcomes. These issues should temper overgeneralization.
Nevertheless, STAMINA addresses one of the most persistent obstacles confronting Exercise Oncology: implementation.
We already have substantial evidence that exercise can benefit people living with and beyond cancer. STAMINA demonstrates something different and equally necessary that structured exercise can be incorporated into the clinical pathway, connected to community infrastructure, sustained over time, delivered at scale, and economically justified.
The CancerFitness.org Perspective
The future of Exercise Oncology will depend on moving beyond telling patients to “be more physically active.”
Cancer programs need systems that can identify, assess, refer, prescribe, supervise, monitor, and support patients throughout treatment and survivorship.
STAMINA provides a practical blueprint for doing exactly that.
Call to Action
Cancer centers, oncology practices, hospitals, insurers, fitness organizations, and healthcare policymakers should begin treating structured exercise as an implementable component of cancer care, not merely as lifestyle advice.
The STAMINA trial demonstrates that the infrastructure can be built. The clinical benefits can be measured. Patients can remain engaged. Community exercise professionals can become part of the care pathway. And the program can be economically defensible.
For organizations considering development of an Exercise Oncology Program, the question is increasingly no longer whether exercise belongs in cancer care.
The question is how quickly we can build the referral pathways, professional workforce, safety systems, community partnerships, and reimbursement models necessary to make it routinely available to every appropriate cancer patient.
CancerFitness.org is advancing Exercise Oncology from evidence to implementation.
Reference: An integrated lifestyle intervention for mitigation of adverse effects associated with androgen deprivation therapy for prostate cancer (STAMINA): a multicentre, randomised trial. Liam Bourke, Derek J Rosario, Sophie Reale, Said Ibeggazene, Aidan Innes, Alison Scope, Grace Price, et al. Lancet Oncol 2026, Published online September 4, 2026, https://doi.org/10.1016/S1470-2045(26)00304-9.
